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HOME   TREATMENT 


OF    TUBERCULOSIS 


IN 


NEW   YORK   CITY 


Jan.  8,  1906— Oct.  i,  1907 

An  Account  of  20  months'  experience  of  the  Committee  on  the 
Prevention  of  Tuberculosis  of  the  New  York  Charity 
Organization  Soeiety. 


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HOME    TREATMENT 


OF   TUBERCULOSIS 


IN 


NEW    YORK    CITY 


Jan.  8,  1906 — Oct.  i,  1907 

Being  a  R.eport  of  the  Relief  Committee  of  the  Committee  on 
the  Prevention  of  Ttibercnlosis  of  the  New  York  Charity 
Orgfanization  Societ}^. 

March,  1908 


C3  1J 


TABLE  OF  CONTENTS 

PAGE 

Org-anization  of  Relief  Committee      -         -         -         -         -         8 

Plan  of  Operation      --------         q 

Medical  Reports  as  a  Basis         ------       lo 

Committee  Recommendations    ------       12 

General  Scope  of  Relief      -         -         -         -         -         -         -13 

Forms  of  Relief  -         -         -         --         -         -         -16 

Results  Obtained        --------       ig 

Home  Treatment        -         -         -         -         --         -         -21 

Day  Camp  ---------24 

Combined  Treatment,  Home  and  Day  Camp     -         -         -       28 
Sanatoria  Treatment  -------29 

Treatment  in  the  Country  -         -         -         -         -         -31 

A  System  of  Tuberculosis  Dispensaries      -         -         -         -       35 

Extra  Dispensary  Treatment      ------       38 

Conclusions        ---------       3g 

Financial  Statement  _______       47 


COM.MITTEE    ON    THE    PRE\'EXTION    OF 
TUBERCULOSIS 

Edgar  T.  Levev,  Cliairman 


Hermann  AI.  Biggs,  ]\I.  D. 
J.  S.  Billings,  Jr.,  M.  D. 
David  Blaustein 
John  W.  Brannan,  AI.  D. 
Herbert  S.  Brown 
Joseph  D.  Bryant,  'M.  D. 
Edmond  J.  Butler 
Charles  F.  Cox 
Thos.  Darlington,  I\I.  D. 
Robert  W.  be  Forest 
Edward  T.  Devine 
Homer  Folks 
Lee  K.  Frankel 
Robt.  W.  Hebberd 
L.  Emmett  Holt,  AL  D. 
J.  H.  Huddleston,  ]\L  D. 
A.  Jacobi,  ]\L  D. 
Walter  B.  James,  ]\L  D. 
E.  G.  Janeway,  ^l.  D. 
i\Iiss  A.  B.  Jennings 


S.  A.  Knopf,  AL  D. 

Alexander  Lambert,  M.  D. 

Ernst  J.  Lederle 

Egbert  Le  Fevre,  M.  D. 

Henry  I\L  Leipziger 

Alfred  AIeyer,  ]\L  D. 

James  Alex.  [Miller,  AL  D. 

Thos.  M.  Mulry 

Mrs.  James  E.  Xewcomb 

Eugene  A.  Philbin 

T.  IMitchell  Prudden,  M.  D. 

E.  .Guernsey  Rankin,  M.  D. 

Andrew  H.  Smith,  ]\L  D. 

Antonio  Stela,  M.  D. 

W.  G.  Thompson,  M.  D. 

E.  L.  Trudeau,  AL  D. 

Lawrence  A'eiller 

Fred'k  L.  Wachex'heim,  AL  D. 

John'  Seeley  Ward,  Jr. 

B.  H.  Waters,  Isl.  D. 


Paul  Kennaday,  Secretary - 
Frank  H.  ]\L\nn,  Assistant  Secretary 


co:\nnTTEE  ox  relief 

James  Alex.  AIiller,  AI.  D.,  Chairman 


R.  A.  Eraser,  AI.  D. 
James  C.  Greenway,  ]\I.  D. 
S.  F.  Hallock,  ~\\.  D. 
J.  H.  Huddleston,  ]\I.  D. 
Walter  L.  Niles,  M.  D. 


W.  F.  Persons 

Henry  L.  Shively,  ]\I.  D. 

A.  M.  Shr.\dy,  AI.  D. 

B.  H.  Waters,  M.  D. 
Gaylord  S.  White 


Henry  S.  Patterson.  AI.  D.         Paul  Kennaday,  Secretary 
Frank  H.  ]\Iann,  Assistant  Secretai-y 


HOME    TREATMENT    OF    TUBERCULOSIS    IN    NEW 

YORK  CITY. 

With  the  development  of  interest  in  the  subject  of  tuberculosis, 
in  New  York  City  in  recent  years  and  the  accompanying  increase 
in  the  number  of  agencies  caring  for  the  tuberculous  poor,  physi- 
cians and  charity  workers  have  been  more  and  more  impressed 
that  something  further  was  needed  in  the  treatment  of  this  class 
of  the  sick  than  had  been  heretofore  had.  While  dispensaries 
for  the  treatment  of  tuberculosis  were  each  year  increasing  in 
number,  and  clinic  classes  becoming  larger,  at  the  same  time  cases 
of  tuberculosis  referred  to  organizations  administering  relief  were 
becoming  more  and  more  frequent.  Lack  of  adequate  funds 
prevented  the  Charity  Organization  Society  from  providing  the 
special  treatment  necessary  to  enable  it  to  co-operate  effectively 
with  the  dispensaries  in  the  treatment  of  these  cases  ;  the  supplying 
of  special  diet,  the  making  good  of  the  wage  loss  resulting  from 
the  absence  of  the  bread  winner  in  a  hospital  or  sanatorium,  the 
paying  of  rent  in  lighter  and  better  rooms,  were  all  out  of  the 
question  without  the  provision  of  special  means  to  enable  the 
society  to  meet  these  needs. 

Accordingly,  in  the  early  part  of  1906  steps  were  taken  to  raise 
sufficient  funds  to  carry  on  this  work  on  a  large  enough  scale  and 
for  a  sufficient  length  of  time  to  make  the  experiment  worth  while. 
Through  the  generosity  of  eight  men  a  fund  of  $20,500  was 
subscribed  for  the  first  year's  work ;  of  this  $4,500  was  renewed 
during  the  second  year,  with  $8,496.40  secured  from  special  funds 
of  the  society,  small  contributions  and  interest,  making  a  total  of 
$33,496.40  available  for  the  work  during  the  entire  twenty  months 
-of  the  experiment. 


8 

ORGAXIZATIOX  OF  RELIEF  CO.ALAIITTEE. 

To  the  Committee  on  the  Prevention  of  Tuberculosis,  to  whom 
the  administration  of  this  fund  was  entrusted,  it  seemed  that  the 
work  might  best  be  done  through  a  sub-committee,  composed  on 
the  one  hand  of  physicians  directly  responsible  for  the  larger  part 
of  the  special  tuberculosis  dispensary  work  carried  on  in  the  city, 
and  on  the  other  hand  of  such  members  of  the  Charity  Organiza- 
tion Society  as  could  particularly  well  represent  the  general  policy 
of  the  Society  in  the  matter  of  relief  and  charitable  assistance.* 

A  Committee  on  Relief  was  therefore  organized  with  the 
following  personnel : 

Dr.  James  Alexander  Miller,  Chairman,  Director  Bellevue 
Hospital  Tuberculosis  Clinic; 

Dr.  J.  H.  HuDDLESTON,  A'isiting  Physician  Gouverneur 
Hospital ; 

Dr.  B.  H.  Waters,  Chief  of  Tuberculosis  Clinics,  Department 
of  Health ; 

Dr.  Hexry  L.  Shively,  Physician  in  Charge  Department  of 
Heart  and  Lungs,  Presbyterian  Hospital ; 

Dr.  S.  F.  Hallock,  Chairman  of  C.  O.  S.  Committee  on 
District  Work ; 

Mr.  Gaylord  S.  White,  Alember  of  Yorkville  District 
Committee  of  C.  O.  S. ; 


*For  the  benefit  of  those  not  familiar  with  the  work  of  the  Charity  Organization  Society  the 
following  statement  is  given  of  the  methods  employed  with  applicants  for  assistance: 

In  the  first  instauce,  applicants  for  relief  are  reportel  to  the  Registration  Bureau.  If  they  are 
found  to  be  cases  already  under  the  care  of  the  Association  for  Improving  the  Condition  of  the 
Poor,  or  Jewish  cases,  coming  under  the  supervision  of  the  United  Hebrew  Charities,  they  are 
referred  to  one  or  the  other  of  those  societies,  which  then  take  entire  charge  of  the  case.  If  they 
are  new  cases,  or  former  C.  O.  S.  cases,  the  Investigating  Department  makes  such  inquiry  as  is 
necessary,  and  where  the  need  is  but  tempoiary,  keeps  them  under  care  until  that  need  has  been 
met.  If,  on  the  other  hand,  the  case  is  one  requiring  more  or  less  extended  treatment,  it  is  then 
made  a  -'district  case"  and  sent  for  supervision,  relief,  if  necessary,  to  one  of  the  ten  district 
offices  of  the  Society  located  in  various  parts  of  Manhattan  and  in  the  Bronx. 

These  district  offices  are  each  in  charge  of  a  district  agent,  who  is  advised,  at  stated  times,  by 
her  district  committee.  Through  frequent  discussions  of  individual  cases  by  district  agents  and 
the  officer  in  the  Central  Office  having  general  charge  of  the  Society's  "case  work."  bv  regular 
^^•eekly  meetings  between  all  agents  and  the  General  Secretary  of  the  Society  and  by  a  Committee 
on  District  Work,  meeting  every  two  weeks  and  composed  of  representatives  from  district 
committees,  the  general  policy  of  the  Society  is  kept  uniform  and  at  the  same  time  latitude  is 
given  to  the  districts  to  carry  out  such  measures  as  they  consider  best  fitted  to  the  solution  of 
their  individual  cases. 


*  Mr.  C.  C.  Carstens^  Assistant  Secretary  of  C.  O.  S.  in 
charge  of  the  case  work  of  the  Society ; 

fMR.  Paul  Kennaday^  Secretary  of  the  Committee  on  the 
Prevention  of  Tuberculosis  of  the  C.  O.  S. 

There  were  later  added :  Dr.  R.  A.  Eraser,  Attending  Physi- 
cian to  New  York  Dispensary ;  Dr.  James  C.  Greenway,  Chief  of 
Clinic  and  Associate  Attending  Physician  to  New  York  Hospital ; 
Dr.  Walter  L.  Niles,  Physician  in  Charge  of  Christ  Church 
Tuberculosis  Class ;  Dr.  Henry  S.  Patterson,  Chief  of  Clinic 
Department  of  Applied  Therapeutics,  Vanderbilt  Clinic ;  Mr.  W. 
F.  Persons,  Superintendent,  Charity  Organization  Society ;  Dr. 
A.  M.  Shrady,  Assistant  Visiting  Physician  to  Harlem  Hospital. 

To  this  Committee  was  turned  over  the  relief  work  of  the 
Committee  on  the  Prevention  of  TuTDcrculosis  with  no  restrictions 
other  than  that  this  fund  should  be  used  for  the  relief  of  those 
suffering  from  tuberculosis. 

PLAN  OF  OPERATION. 

Various  methods  for  carrying  on  this  work  were  open  to  the 
Committee,  all  containing  good  points  and  all  open  to  some  objec- 
tions. It  was  finally  decided  that  on  the  whole  the  best  results 
were  to  be  obtained  through  making  use,  as  far  as  possible,  of  the 
agencies  already  at  hand  in  the  Charity  Organization  Society  and 
in  the  tuberculosis  dispensaries  in  the  city.  This  decision  was 
based  upon  the  conviction  that  the  treatment  of  tuberculosis  is  a 
municipal  problem  and  that  however  large  the  relief  fund  at  the 
Committee's  disposal,  the  individuals  to  be  directly  benefited 
through  financial  assistance  will  necessarily  be  but  a  small  portion 
O'f  the  total  of  those  requiring  such  aid.  For  this  reason  the 
Committee  felt  that  it  should  sO'  plan  its  work  that  its  influence 
in  the  treatment  of  particular  cases  would  be  effective  on  the 
larger  problems  of  dispensary  and  charitable  care  of  consumptives 
in  general. 

It  further  believed  that  the  plan  thus  adopted  would  prevent 
the  duplication  of  existing  machinery,  that  there  would  be  avoided 
the  unnecessary  sending  of  additional  visitors  among  the  con- 

*  Mr.  Carstens  resigned  on  December  31st,  1906. 
t  Mr.  Kennaday  resigned  on  November  18th,  1907. 


lO 

sumptive  poor,  and  that  also  the  expenses  of  administration  would 
thus  be  reduced  to  a  minimum. 

Such  actual  experience  as  was  at  hand  to  go  by — that  gained 
in  1903,  when  for  a  short  period  the  Committee  on  the  Prevention 
of  Tuberculosis  took  over  the  relief  work  of  the  Charity  Organi- 
zation Society  in  families  in  which  tuberculosis  existed — seemed 
to  show  that  it  would  be  best  to  leave  the  actual  relief  of  persons 
applying  for  aid  to  the  usual  agencies  of  the  Society,  and  not  to 
try  to  separate  the  relief  of  the  consumptive  patient  from  the  care 
and  continuing  oversight  of  the  consumptive's  family.  For, 
tuberculosis  among  the  poor  of  the  New  York  tenements  is  inex- 
tricably bound  up  with  accompanying  conditions  requiring  just 
such  care  as  the  Charity  Organization  Society  is  designed  to  give. 

MEDICAL  REPORT  AS  A  BASIS. 

The  Committee  has  carried  on  its  work  in  the  following 
manner:  As  a  basis  for  the  consideration  of  a  case  the  Com- 
mittee has  required  a  medical  report  showing  the  stage  of  disease, 
whether  the  patient  is  ambulant  or  in  bed,  what  the  general 
condition  is,  the  patient's  ability  to  work,  the  prognosis,  whether 
extra  diet  is  being  given  and  the  examining  physician's  recom- 
mendations. These  facts  were  reported  in  the  following  manner 
on  a  card  schedule  especially  prepared  for  this  purpose. 

The  reports  were  made  out  by  the  physicians  and  nurses  at 
the  following  dispensaries  and  were  promptly  forwarded  to  the 
Committee  on  Relief:  The  Department  of  Health  Tuberculosis 
Dispensary,  Bellevue  Hospital,  Presb}i;erian  Hospital,  Gouver- 
neur  Hospital,  Harlem  Hospital,  New  York  Hospital  and  New 
York  Dispensaries  and  the  Vanderbilt  Clinic. 

Although  in  some  cases  reports  were  received  from  other 
dispensaries  than  those  represented  on  the  Committee,  yet  in  order 
to  obtain,  as  far  as  possible,  uniformity  of  standard,  practically 
all  cases  were  laid  before  the  Committee  after  physical  examina- 
tion at  one  or  the  other  of  those  dispensaries  which  by  the  plan 
of  organization  were  brought  into  very  close  touch  with  the 
relief  work  supervised  by  the  Committee.  Too  much  labor  cannot 
be  asked  from  dispensary  physicians  already  overworked,  and  so 


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the  report  cards  furnished  to  the  dispensaries  did  not  cah  for 
elaborate  information  or  details  of  physical  signs.  Recommen- 
dations as  to  treatment  were,  however,  by  means  of  these  reports 
suggested  by  an  examining  physician,  who  had  full  knowledge 
of  the  physical  condition  of  the  patient,  and  who  was  himself 
either  a  member  of  the  Committee  or  was  working  under  the 
immediate  direction  of  a  member.  It  was  these  recommenda- 
tions which  the  Committee  tried  to  carry  out  so  far  as  practicable, 
modified  as  they  were  by  the  physician  as  he  came  more  fully  to 
understand  the  various  aspects  of  the  problems  of  home  relief. 

CO:\IMITTEE  RECOM^IEXDATIONS. 

Once  each  week  the  Committee  held  a  meeting  at  which  new 
and  old  cases,  sent  in  by  different  departments  of  the  Society, 
came  up  for  consideration.  In  going  over  these  the  Committee 
made  recommendations  as  to  medical  treatment  and  relief,  which 
as  the  work  progressed  became  precedents  by  which  the  Secre- 
tary was  enabled  to  express  the  Committee's  opinion  on  many 
cases  without  laying  them  before  the  Committee  itself.  The  num- 
ber of  new  cases  referred  to  the  Committee,  the  number  of  cases 
resubmitted  at  frequent  intervals  for  further  advice  as  changing 
circumstances  required,  the  general  similarity  of  certain  problems 
presented,  the  need  for  opportunity  to  discuss  questions  of  dispen- 
sary treatment  and  administrative  control,  made  this  procedure 
necessar}',  and  as  the  Secretary's  recommendations  were  at  all 
times  subject  to  review  and  revision  by  the  Committee,  each  mem- 
ber of  which  was  provided  with  full  copies  of  all  decisions  made, 
the  plan  proved  satisfactory  as  well  as  expeditious.  Further,  the 
Secretary  and  other  agents  of  the  Society  were  in  constant  touch 
with  each  other  in  reaching  decisions.  In  order  to  obtain  relief 
from  the  Committee  the  advice  of  the  Committee  had  to  be 
followed  by  the  district  committees,  although  these  departments 
retained  full  charge  of  the  families  referred  to  the  Committee's 
consideration.  That  the  Committee  might  be  able  to  judge  for 
itself  whether  this  was  being  done,  all  cases  referred  to  the 
Committee  were  carefully  indexed  on  card  schedules  on  Avliich 
were  written  a  summarv  of  the  social,  housing  and  medical  condi- 


13 

tions  in  each  case,  together  with  its  history  from  the  time  it  was 
referred  to  the  Committee,  as  well  as  the  Committee's  decisions 
and  the  amount  of  money  expended.  Furthermore,  all  requisi- 
tions for  funds  to  meet  the  Committee  recommendations  were 
always  accompanied  by  the  "case  record,"  giving-  the  full  history 
of  the  case  and  showing  just  what  has  taken  place  since  the 
last  previous  payment.  A  visitor  working  full  time  for  the 
Committee  and  a  visiting  trained  nurse  working  half  time  visited 
the  patients.  The  Committee  itself  met  once  a  week  and  had  as 
its  executive,  in  constant  touch  with  the  situation,  a  secretary 
who  had  general  supervision  and  an  assistant  whose  whole  time 
was  devoted  to  the  work. 

GENERAL  SCOPE  OF  RELIEF. 

Underlying  the  Committee's  recommendations  for  the  treat- 
ment of  individual  cases  have  run  two  main  ideas ;  the  one,  that 
hopeful  cases  should  be  directly  aided  by  the  best  treatment 
practicable ;  the  other,  that  the  consumptive's  family  should  be 
protected  against  infection,  and  that  this  could  best  be  accom- 
plished by  segregation  in  a  hospital  or  a  country  sanatorium. 
Li  the  case  of  most  of  the  second  stage  cases  with  unfavorable 
prognosis,  and  in  nearly  all  third  stage  cases  the  Committee 
has  advised  hospital  treatment  and  has  stood  ready  to  care  for 
the  patient's  family  if  the  advice  were  followed.  For,  it  should  be 
borne  in  mind  that  even  the  scanty  and  occasional  earnings  of  a 
consumptive  are  important  to  many  a  poor  family,  and  often 
objection  to  hospital  care  is  raised  for  this  reason  by  father, 
mother,  husband  or  wife,  even  though  the  bread-winning  power 
of  the  patient  has  been  reduced  to  the  lowest  point,  if  not,  indeed, 
entirely  taken  away  by  sickness.  In  certain  exceptional  instances, 
even  in  this  apparently  hopeless  class,  it  has  been  found  imprac- 
ticable to  advise  hospital  treatment ;  for  instance,  where  a  sick 
mother  was  needed  to  keep  together  a  large  family  depending 
upon  her  guiding  care.  In  such  cases  pains  were  taken  to  reduce 
the  danger  of  infection  to  a  minimum  by  insisting  upon  a  separate 
room  for  the  sick  one  and  by  frequent  visits  on  the  part  of  the 
nurse. 


14 


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Too  frequently,  however',  nothing  will  induce  a  bed-ridden 
patient  to  follow  the  Committee's  advice  and  the  urging  of  the  dis- 
trict agent  to  enter  a  hospital.  Dread  of  hospital,  pride  against  be- 
coming a  public  charge,  reports  of  the  bad  accommodations  and  the 
low  moral  character  of  many  of  the  patients  at  some  hospitals,  all 
this  stands  in  the  way.  For  such  objectors  the  Committee  did  not 
feel  that  it  could  go  beyond  advice  as  to  w^hat  was  regarded  as 
the  proper  treatment  and  the  offer  of  assistance  if  this  advice 
were  followed.  These  cases  were,  therefore,  "closed"  as  Com- 
mittee cases,  and  left  in  charge  of  the  proper  agencies  of  the 
Charity  Organization  Society  and  of  the  inspecting  force  of  the 
Department  of  Health. 

FORMS  OF  RELIEF. 

While  it  has  not  been  necessary  to  reject  many  cases,  certain 
subjects  have  been  withdrawn  from  consideration  as  being 
obviously  inappropriate  for  treatment ;  in  so  doing,  only  the  broad- 
est lines  have  been  followed;  hopeless  third-stage  cases,  chronic 
alcoholics,  and  the  persistently  incorrigible  have  been  practically 
the  only  subjects  rejected.  Some  families  have  been  self-sup- 
porting, and  have  not  needed  relief,  but  only  advice  and  direction. 
A  few  non-tuberculous  cases  were  referred  to  the  Committee,  but 
naturally  were  not  treated.  During  the  Committee's  twenty 
months'  work,  257  cases  were  excluded  for  the  following  reasons : 
Hospital  cases  not  needing  home  relief,  157;  families  self-support- 
ing, not  needing  relief.  34 ;  not  tuberculous,  24 ;  refused  to  follow 
Committee's  directions,  24 :  supported  by  other  relief  funds,  12 ; 
moved  away  from  the  city,  6.  The  Committee  has  administered 
relief  in  one  form  or  another  during  the  period  of  its  work  to  355 
dift'erent  patients  and  their  families;  of  these  166  were  males  and 
189  females;  while  in  these  families  there  were  762  children  16 
years  of  age  and  under. 

The  relief  given  has  been  in  many  dift'erent  wavs.  Money 
frequently  has  been  given  to  make  up  the  loss  to  the  family  of 
the  patient's  wages,  while  he  has  abstained  from  work  or  gone  to 
a  hospital  or  sanatorium  for  treatment ;  rent  has  frequently  been 
paid,  especially  for  more  expensive  quarters  where  light  and  air 
could   be   obtained ;    special    diet   of   milk   and    eggs   have    been 


17 

furnished ;  clothing  and  bedding  have  been  suppUed ;  special 
employment  suited  to  the  patient's  needs  has  been  obtained;  and, 
in  a  word,  all  things  done  that  could  help  the  patient  to  recovery 
or  prevent  the  members  of  his  family  from  becoming  infected. 

That  suitable  cases  might  leave  their  families  to  enter  hospitals 
or  sanatoria,  there  has  been  given  to  31  persons  relief  amounting 
to  $2,238.76  in  the  form  of  "wage  loss,"  to  make  up  the  wages  lost 
by  the  consumptive  through  ceasing  work  in  pursuance  of  advice 
given. 

Twenty-five  other  families  have  been  moved  into  better  rooms, 
the  Committee  paying  moving  expenses  and  excess  of  the  new 
rent  over  the  old,  or  all  of  the  new  rent,  as  the  case  might  be. 

Rent  has  been  paid  for  81  others  in  their  former  apartments, 
where  these  rooms  were  suitable  and  where  also  there  was  a 
separate  room  for  the  consumptive. 

For  22  others  beds  have  been  supplied  so  that  the  patient 
might  have  a^-  separate  bed  in  a  separate  room. 

Special  diet,  usually  in  the  form  of  milk  and  eggs,  has  been 
provided  in  154  cases,  where  the  residence  of  the  patient  was  so 
far  removed  from  a  dispensary  or  diet  kitchen  station  that  the 
patient  was  thus  practically  cut  off  from  this  needed  form  of 
treatment  at  these  agencies,  or  where  it  could  not  be  secured 
through  them. 

Clothing  has  been  supplied  to  75  patients  and  sometimes  to 
their  families  and  was  a  regular  method  of  relief  by  the  Committee 
in  cases  going  to  hospitals  and  sanatoria. 

Through  the  aid  of  the  Committee  on  Employment  for  the 
Handicapped  several  consumptives  have  been  provided  with  em- 
ployment of  a  character  that  seemed  suited  to  their  physical  con- 
dition, such  as  doorkeepers,  messengers;  newsdealers,  handy  men, 
etc. 

Ten  patients  have  been  maintained  in  whole  or  in  part  at  pay 
sanatoria  at  a  cost  of  $1,451.43  for  periods  averaging  from  i^^ 
to  9  months.  This  was  done  because  such  treatment,  though 
expensive,  seemed  the  only  method  open  of  effectually  returning 
these  patients  to  wage-earning  power,  and  the  refusal  to  give 
such  treatment  seemed  likely  to  lead  to  unavoidable  physical 
decline  along  with  the  possibility  of  infection  to  others  of  the 
patient's  family. 


19 

Thirty-seven  other  patients,  through  the  instrumentahty  of  the 
Committee,  were  sent  to  the  New  York  State  Sanatorium  for 
Incipient  Tuberculosis  at  Ray  Brook,  to  the  Municipal  Sana- 
torium at  Otisville  and  to  private  sanatoria  as  free  patients,  and 
provided  with  clothing  or  such  other  assistance  as  was  necessary. 
In  one  of  these  cases,  a  young  girl  of  17  years,  whose  parents  were 
continually  insisting  on  her  working  to  add  to  the  small  family 
income,  the  family  was  prevailed  upon  to  let  her  stay  at  the  sana- 
torium for  six  months  by  the  payment  to  them  each  week  of  $5, 
the  amount  that  the  girl  was  earning  before  taken  out  of  work  by 
friends  who  brought  the  case  to  the  Committee's  attention.  In 
another  case  the  mother  of  five  children  was  enabled  to  go  to  this 
same  institution  in  the  Adirondacks  after  her  children  had  been 
sent  to  a  reliable  home  in  the  country,  where  their  board  was  paid 
by  the  Committee  for  five  months. 

Seventy  patients  have  been  sent  tO'  the  country  for  stays 
varying  from  one  week  to  five  months  and  lasting  in  33  cases  for 
three  months  or  more,  in  25  cases  for  two'  months  and  a  fraction, 
in  9  cases  for  one  month  or  one  month  and  a  fraction,  in  2  cases 
for  one-half  a  month,  and  in  i  case  for  one  week.  This  has 
cost  $5,417.61. 

RESULTS   OBTAINED. 

While  a  full  understanding  of  the  results  obtained  from  the 
Committee's  work  can  be  best  had  from  a  study  of  the  detailed 
tables  accompanying  this  report,  the  following  synopses  of  a 
few  case  records  throw  much  light  on  this  whole  subject: 

A  widow  with  four  children  was  forced  to  receive  aid 
when  her  eldest  boy,  the  main  bread-winner  of  the  family, 
was  compelled  to  give  up  his  work  on  account  of  tuber- 
culosis. The  Committee  paid  his  wage  loss  while  he  took 
the  cure  at  Otisville  Sanatorium.  An  examination  of  the 
other  members  of  the  family  revealed  that  two  of  the 
children  were  in  the  early  stages  of  the  disease.  The 
pension  in  the  home  was  increased  and  these  two  were 
sent  to  Ray  Brook.  The  mother  bore  up  bravely  under 
her  misfortunes  and  after  a  few  months  the  family  was 
reunited  and  the  two  boys  resumed  their  work. 


20  ■ 

A  young  girl  20  years  of  age  who,  with  her  sister,  was 
the  main  support  of  a  feeble  grandmother,  after  remaining 
a  short  while  in  one  of  the  city  hospitals,  was  referred  to 
the  Committee  for  charitable  assistance.  She  was  sent 
into  the  country  for  three  months  at  the  Committee's 
expense  and  returned  in  excellent  condition,  having  gained 
20  pounds.  A  suitable  position  was  soon  secured  for  her 
and  the  family  was  put  on  an  independent  basis. 

A  young  man,  25  years  of  age,  with  a  wife  and  one 
small  child,  presented  quite  a  problem,  after  having  refused 
treatment  in  a  sanatorium  because  there  were  "too  many 
sick  people  there"  and  after  giving  up  several  positions  in 
the  city.  For  nearly  a  3^ear  his  rent  was  paid  and  food 
was  supplied  to  the  family.  At  last  a  position  was  secured 
for  him  in  the  country,  where  he  established  himself  and 
later  moved  his  wife  and  child,  becoming  independent  of 
any  charitable  assistance. 

A  father,  53  years  of  age,  suffering  with  advanced 
tuberculosis,  filthy  in  person,  living  with  a  wife  and  nine 
children  in  three  small,  dirty  rooms,  was  a  dangerous 
source  of  infection  when  the  case  came  to  the  Committee's 
notice.  When  persuasion  failed  to  induce  the  man  to 
enter  a  hospital,  the  law  was  appealed  to  and  the  man 
was  forcibly  removed  to  Riverside  Sanatorium.  The 
wage  loss  of  the  wife,  now  forced  to  give  up  her  work  to 
care  for  the  children,  was  made  up  by  the  Committee  and 
the  rent  was  paid.  The  man's  removal  was  the  family's 
redemption.  The  whole  tone  of  the  household  was  elevated 
and  at  the  end  of  ten  months,  though  the  woman  was 
faithful  in  visiting  "her  man''  at  the  hospital,  she  would 
not  listen  for  a  moment  to  his  entreaties  to  return  home. 

A  widow  with  two  children,  unable  to  do  a  full  amount 
of  work  and  yet  unwilling  to  have  her  home  broken  up,  that 
she  might  go  into  a  hospital,  was  paid  three  days'  wage 
loss  each  week,  which  enabled  her  to  take  "the  cure"  at 
home.  During  the  summer  she  spent  at  least  three  days 
a  week  at  the  camp,  improving  steadily,  and  when  the 
Committee's  work  ceased  she  was  quite  ready  to  resume 
the  full  support  of  her  family. 


21 

A  young  woman,  24  years  of  age,  living  with  distant 
relatives,  who  were  unwilling  to  keep  her  longer  unless 
she  could  work  and  pay  her  way,  was  forced  in  her  ex- 
tremity to  apply  for  assistance.  When  she  first  came 
under  the  Society's  care,  she  had  been  rejected  by  one  of 
the  sanatoria  as  an  unsuitable  case  for  sanatorium  treat- 
ment. Her  board  was  paid,  milk  and  eggs  were  supplied, 
the  home  was  frequently  visited  by  an  experienced  nurse, 
the  girl  attended  clinic  regularly  each  week  and  was  so 
improved  at  the  end  of  three  months  that  a  position  was 
secured  for  her  as  a  domestic  at  the  Municipal  Sanatorium 
at  Otisville. 

A  young  man,  22  years  of  age,  boarding  with  friends, 
was  forced  to  give  up  his  work  on  account  of  tuberculosis 
and  was  referred  by  one  of  the  clinics  to  the  day  camp. 
After  eight  weeks'  treatment  there,  during  which  time  the 
Committee  paid  his  wage  loss,  he  was  so  improved  as  to 
be  able  to  resume  his  work  as  street  car  conductor. 

A  young  girl,  21  years  of  age,  broken  down  through 
hard  work  in  a  tobacco  factory  and  suffering  with  tuber- 
culosis in  the  incipient  form,  was  referred  by  one  of  the 
clinics  to  spend  her  vacation  of  one  week  at  the  day  camp. 
She  was  persuaded  to  continue  treatment,  the  Committee 
paying  her  wage  loss,  and  after  fourteen  weeks,  having 
gained  twelve  pounds,  she  was  so  improved  that  she  could 
not  be  persuaded  to  remain  longer  at  the  camp. 

The  Committee's  main  activities  have  been  in  five  directions — 
Home  Treatment ;  the  Day  Camp ;  Country  Treatment ;  Sana- 
torium Treatment ;  and  the  Establishment  of  a  Proper  System 
of  Tuberculosis  Dispensaries : 

HOME  TREATMENT. 

For  the  hundreds  who  either  will  not  or  cannot  go  to  a 
hospital  or  sanatorium,  home  treatment  is  essential.  Here,  not- 
withstanding the  limitations  under  which  we  are  working  in 
New  York  City,  everything  possible  must  be  done  for  the  patient 


22 

to  restore  him  to  his  position  as  a  useful  member  of  society,  and 
more  especially  to  protect  the  members  of  his  family  and  of  the 
other  families  living  in  close  proximity  to  him,  from  the  disease. 
Here,  too,  must  the  patient  be  taught  those  essentials  as  to  the 
nature  of  his  disease,  and  the  means  of  combating  it  which 
ordinarily  would  be  learned  in  the  sanatorium. 

The  Committee  during  the  period  of  its  activity  has  adminis- 
tered Home  Relief  to  127  families;  that  is,  the  patients  were 
treated  not  in  hospitals,  sanatorium,  or  day  camps,  but  exclusively 
in  their  own  homes. 

In  every  case  efforts  were  made  to  secure  the  most  sanitary, 
wholesome  and  propitious  living  conditions  for  the  patient.  The 
sunniest  and  airiest  room  was  always  reserved  for  him,  a  sep- 
arate bed  was  considered  essential  and  a  separate  room  was  the 
rule  with  but  few  exceptions.  In  a  word,  everything  affecting 
the  life  of  the  patient  was  carefully  supervised — from  the  social 
side  by  the  districts  of  the  Charity  Organization  Society,  from  the 
medical  side  by  the  nurses  and  physicians  of  the  special  tubercu- 
losis clinics — and  the  life  of  the  patient  brought  to  as  high  a 
degree  of  regularity  as  the  conditions  and  circumstances  permitted. 

The  following  table  shows  the  results  obtained  from  this 
method,  so  far  as  it  is  possible  to  state  statistically  the  results  of 
such  treatment : 

Table  I.  ■  • 

Home  Treatment — 127   Cases. 


Been  Its 
Obtained 

Condition  at 

Bbqinning 

35 

Incipient 

80  Moderately  Ad- 
vanced 

12  Far  Advanced 

Total 

Percent- 
age 

Good 

Pair  f  Poor 

Good     Fair    Poor 

Good   Fair     I'oor 

Appstrently  cured  . 

2    '            \ 

1 

3 

2 

Arrested 

8 

1     i     1 

4           3 

17 

18 

Improved 

7 

4 

12     1     19     1       2 

1 

45 

36 

Progressive 

8 

4 

9         23           4 

5           6 

r>2 

49 

Total 

25 

9           1 

25     !     49     1       6 

6           (5 

127 

100 

23 


24 

It  appears  from  this  table  that  with  the  127  patients  treated 
exclusively  in  their  homes,  excellent  results  have  on  the  whole 
been  obtained,  in  view  of  the  obstacles  that  exist  to  this  method 
of  treatment.  For  instance,  out  of  35  incipient  cases  thus  treated, 
in  but  12  or  34  per  cent,  did  the  disease  progress,  while  in  23  cases 
or  66  per  cent,  the  patient's  condition  materially  improved. 

Of  the  80  cases  originally  diagnosed  as  "moderately  ad- 
vanced," such  favorable  results  naturally  could  not  be  expected, 
yet  even  here  good  results  have  been  achieved.  In  but  39 
cases  or  49  per  cent,  did  the  disease  progress,  while  in  41  cases  or 
51  per  cent,  the  patient's  condition  improved.  In  the  12  cases 
originally  diagnosed  as  "far  advanced,"  the  story  is  of  course 
different;  of  these  but  one  case  improved. 

Of  the  total  127  cases,  considered  irrespective  of  their  original 
condition,  in  62  cases  or  49  per  cent,  the  disease  progressed,  while 
in  65  or  51  per  cent,  the  patients  improved. 

The  cost  of  securing  these  results  has  been  $12,907.34.  This 
has  been  for  a  total  of  4,343  weeks.  The  average  treatment  per 
patient  has  been  for  34  weeks,  the  total  cost  per  patient,  $101.63, 
and  the  average  cost  per  patient  but  $2.97  per  week.  In  this 
connection  it  should  be  remembered  that  this  cost  includes  not 
only  the  money  spent  specifically  for  the  patient,  but  that  spent  for 
the  family  as  well. 

THE  DAY  CA:\IP.   .  ■ 

The  experience  of  others  pointed  out  the  "day  camp""  as  an 
essential  part  of  any  adequate  scheme  of  home  relief  for  con- 
sumptives. \^arious  plans  were  considered  by  the  Committee ; 
vacant  lots  in  the  Bronx,  a  part  of  Blackwell's  Island,  unused 
corners  of  some  of  the  far  uptown  parks,  hospital  roofs,  boats  and 
recreation  piers  and  finally  one  of  the  old  Staten  Island  ferr\-boats 
that  since  the  building  of  the  new  ferryboats  by  the  city  had  been 
lying  idle  at  one  of  the  Xorth  River  piers.  Through  the  courtesy 
of  Hon.  John  A.  Bensel,  Commissioner  of  Docks  and  Ferries,  the 
"Southfield"  was  thus  put  at  the  Committee's  disposal  free  of  all 
expense  and  with  the  privilege  of  making  such  minor  alterations 
and  repairs  as  were  necessary  for  the  new  and  strange  use  to 


25 

which  the  old  boat  was  to  be  put.  Moored  at  the  end  of  the 
dock  at  the  foot  of  West  Sixteenth  Street,  in  the  Hudson  River, 
exposed  to  the  cool  summer  river  breezes,  with  constantly  shifting 
scenes  furnished  by  the  passing  river  craft,  the  decks  of  the 
"Southfield,"  liberally  supplied  with  steamer  chairs  and  ham- 
mocks, gave  relief  from  the  stifling  heat  of  the  tenements  to 
many  a  poor  consumptive  who  could  not  go  to  a  sanitorium  be- 
cause too  sick  or  because  needed  at  home.  From  every  point  of 
view,  health,  happiness,  comfort  and  economy,  the  boat  has  been 
a  success.  It  received  only  those  sent  by  the  associated  dispen- 
saries, paying  carfares  for  those  whom  investigation  by  relief 
societies  showed  to  be  too  poor  to  pay  these  themselves;  it  gave 
them  an  abundance  of  milk  and  eggs  and  bread  and  butter,  adding 
to  this  in  the  last  month  and  a  half,  a  simple  cooked  dinner. 
Every  patient  was  carefully  watched  by  the  Committee's  efficient 
nurse,  Mrs.  Helen  Smith;  their  temperature  was  taken  twice  a  day 
and  their  weight  and  pulse  every  morning.  This  care,  added  to 
such  advice  as  the  visiting  physician  might  give  in  individual 
cases  or  as  the  examining  dispensary  physician  might  have  noted 
on  the  patient's  record  card  when  sending  him  to  the  boat, 
furnished  satisfactory  medical  oversight. 

While  the  general  success  of  the  camp  may  be  thus  almost 
unqualifiedly  commended,  the  attendance  was  regrettably  small. 
The  camp  was  opened  on  June  13,  1907,  and  closed  on  October  31, 
1907.  Out  of  242  different  patients  who  presented  themselves  at 
one  time  or  another  during  the  141  days  in  which  the  camp  was  in 
operation,  only  87  attended  for  20  days  or  more.  The  average 
daily  attendance  at  the  camp  was  39.4 — a  very  small  figure  when 
we  consider  that  there  were  accommodations  for  at  least  100 
patients  and  that  the  Manhattan  tenements  hold  30,000  tubercu- 
lous patients,  a  large  number  of  whom  might  have  availed  them- 
selves of  the  privilege  of  the  camp.  The  meagre  attendance  is 
at  least  partly  explained  by  the  fact  that  this  was  the  initial  year 
of  the  work  and  the  camp  had  established  no  prestige  which 
would  appeal  to  health  seekers  who  must  limit  their  search  to  the 
City  of  New  York.  This,  however,  is  probably  the  least  reason 
to  which  we  may  appeal  in  explanation  of  why  242  patients,  who 
for  at  least  a  few  hours  tested  the  merit  of  the  "Southfield,"  did 


26 

not  make  a  better  showing  of  attendance.  Some  found  it  impos- 
sible to  make  the  long  journey,  either  from  the  upper  east  side  or 
the  upper  west  side  or  from  the  lower  east  side,  and  some  living 
in  the  Bronx  found,  of  course,  the  same  difficulty — a  reason  foi 
the  establishment  of  a  number  of  camps  which  would  be  readily 
accessible  to  the  various  crowded  tenement  sections.  Some  had 
duties  at  home  which  made  more  than  a  very  occasional  attend- 
ance impossible:  they  consequently  never  contracted  the  habit 
of  coming — a  reason  for  providing  in  connection  with  the  camp 
for  the  home  relief  and  home  supervision  of  all  those  who 
attend.  Quite  a  number,  through  one  agency  or  another,  found 
their  wa}"  to  the  country  for  the  summer  months  and  not  a  few 
through  their  association  with  the  camp  secured  admission  to 
Rav  Brook  or  Otisville  Sanatoria  and  were  transferred  there.  A 
few  suffered  from  seasickness  on  board  the  "Southfield"  and  pre- 
ferred to  tr}'  the  parks  and  roofs.  The  rest  may  be  classified  as 
those  who  for  no  apparent  reason  simply  did  not  care  to  come. 

The  camp  was  open  Sundays  as  well  as  week  days,  and  while 
the  attendance  was  unusually  small  on  those  days,  the  number  of 
Sundays  as  compared  with  the  other  da}'s  was  so  few,  that  it  made 
no  considerable  difference  in  the  average  attendance.  The  aver- 
age attendance  on  Sundays  was  24.4,  the  average  attendance  on 
week  day?  was  41.9,  the  general  average  attendance  was  39.4. 

Table  IL        .  '      - 

Day  Camp — Results  with  %j  Patients  for  20  Days  or  ]\Iore. 


Condition  ox  Admission 


Results 

Obtained 

97  Incipient 

47  Moderately  Ad- 
vanced 

13  Far  Advanced 

Total 

Percent- 
age 

■  Good :  Fair    Poor 

Good'  Fair  i  Poor 

Good    Fair    Poor 

Improved 

17    :     4 

8         23           3 

1           4 

60 

m 

Progressive 

5           1 

1           8           4 

e        4        -2 

-7 

31 

Total 

■3-:!           5 

9         31            7 

■2           5           6 

87 

100 

It  appears  from  this  table  that  of  the  87  patients  who  came 
to  the  day  camp  for  20  days  or  more,  very  satisfactory  results 


27 

have  been  secured.  Out  of  27  incipient  cases  there  treated  in  but 
6  or  22  per  cent,  did  the  disease  progress,  while  in  21  cases  or 
78  per  cent,  the  patient's  condition  improved. 

Of  the  47  cases  originally  diagnosed  as  "moderately  ad- 
vanced," but  13  or  only  2'j  per  cent,  progressed  while  34  or  72 
per  cent,  improved. 

Even  among  the  cases  diagnosed  as  "far  advanced,"  good 
results  were  obtained;  out  of  13  cases  of  this  kind  but  8  were 
progressive,  while  5  of  them,  improved. 

The  following  summary  of  the  results  of  the  day  camp 
treatment  and  the  cost  of  running  the  camp  with  other  details 
is  of  interest : 

*  Summary  of  87  Cases  Who  Attended  20  Days  or  More. 
General  Condition. 

Improved 60  69% 

Progressive  27  31% 

Weight. 

Gain    66 

lyoss    19 

Stationary   2 

General  Statistics  of  Day  Camp. 

Total  number  of  days  open 141 

Total  number  of  patients  treated — • 

Male   144 

Female  98 

Number  of  cases  who  attended  20  days  or  more   during 

season    87 

Male    49 

Female   38 

Total  number  of  attendances 5,567 

Average  attendance  per  day 39.4 

Average  attendance  on  Sundays 24.4 

Average  attendance  on  week  days 41.9 

Maximum  attendance 70 

Total  cost $2,790.21 

Equipment — 

Supplies   $515.82 

Wages    ■     51.56 

Total     $567.38 

*It  may  be  interesting  to  note  that  of  these  87  cases  treated  at  the  day  camp  for  20  daye  or 
more,  30  improved  as  to  their  pulmonary  condition;  50  were  stationary  and  only  17  progressed. 


28 

Maintenance — 

Supplies   474-5<J 

Medical    Supplies 32-51 

Wages    '. .  806.13 

Contingent    25.00 

Milk,    eggs 686. 19 

Washing    16.7S 

Carfares     , 181.75 

Total     $2,222.83 

Total  cost  per  day 15-76 

Total  cost  per  patient 56.41 

Total  cost  per  patient  per  day .40 

A  comparison  of  the  results  obtained  with  the  87  day  camp 
patients  and  the  127  cases  treated  at  home,  is  of  interest. 

Out  of  127  cases  treated  exchtsively  m  their  homes,  65 
improved,  and  in  62  the  disease  progressed.  Out  of  87  cases 
treated  at  the  camp  60  improved,  in  27  the  disease  progressed. 
That  is,  69  per  cent,  improved  under  camp  treatment  as  against 
51  per  cent,  improved  under  home  treatment. 

COMBINED  TREATMENT— HOME  AND  DAY  CAMP. 

Out  of  87  patients  treated  at  the  day  camp  for  a  period  of 
20  days  or  more,  there  were  12  who  received  rehef  and  supervi- 
sion in  their  homes  b}^  this  Committee.  In  each  instance  these 
patients  came  to  us  originally  because  they  had  been  referred  to 
the  camp  by  the  clinics,  and  were  able  to  attend  the  camp  because 
of  the  relief  which  was  given  them  in  their  homes.  Although  the 
number  of  cases  treated  both  at  home  and  at  the  camp  is  very 
small,  it  is  added  here  for  the  comparison  with  the  figures  of  the 
two  methods  taken  separately. 

Table  III. 
Combined  Day  Camp  and  Home  Treatment — 12  Cases. 


CONDITION    ON    ADMISSION 

Eesnlts 
Obtained 

4  Incipient 

8  Moderately  , 
Advanced 

12  Total 

Total 

Percent- 
age 

Good     Fair  !  Poor 

Good     Fair  !  Poor 

Good  1  Fair  ,  Poor 

Improved 

3 

j    4  :    2 

3     1      4     '       2 

9 

75 

Progressive 

1 

■                  2 

11            12 

3 

25 

Total 

4 

4            4 

4           4           4 

12 

100 

29. 

Out  of  12  cases  of  this  combined  treatment  9  improved  and 
in  3  the  disease  progressed,  a  per  cent,  of  75  improved  under 
combined  treatment. 

Cost  of  Home  Relief  of  12  Patients  Who  Attended  Day  Camp. 

Total  number  of  weeks 113 

Total  amount  expended $434.75 

Average  length  of  treatment  in  weeks  per  patient 9.4 

Average  cost  per  patient $36.23 

Average  cost  per  patient  per  week 3.84 

The  statement  of  expenses  given  above  in  connection  with  the 
12  day  camp  patients  refers  only  to  the  amount  expended  in  the 
home  in  behalf  of  these  patients.  In  order  to  know  the  total 
amount  expended  in  behalf  of  these  12  patients,  we  must  add  to 
the  above  cost  $303.95,  which  is  the  pro  rata  cost  for  their  camp 
treatment.  Assuming  that  the  results  obtained  in  treating  even  so 
small  a  group  of  patients  is  of  some  value,  the  figures  show  that 
a  patient  may  be  given  the  advantages  of  day  camp  treatment 
and  at  the  same  time  adequate  home  care  at  a  cost  of  $6.53  per 
week.  The  number  of  cases  treated  at  home  and  at  the  same  time 
attending  the  day  camp  is  hardly  large  enough  to  be  very  valuable 
for  purposes  of  comparison,  but  it  may  be  noted  in  passing  that 
75  per  cent,  of  those  so  treated  improved  as  against  51  per  cent, 
improved  of  those  who  did  not  have  the  advantages  of  the  camp 
life. 

It  may  also  be  of  value  in  considering  the  percentages  of 
improved  cases  to  compare  also  the  average  cost  of  treatment : 

The  average  cost  per  patient  per  week  for  home  treatment     $2.97 
The   average  cost  per  patient  per  week  for  day  camp 

treatment 2.80 

The  average  cost  per  patient  per  week  for  combined  treat- 
ment        6.53 

SANATORIUM  TREATMENT. 

As  must  naturally  be  expected,  both  because  of  a  more  careful 
selection  of  cases  and  because  of  better  facilities,  the  sanatorium 


30 

cases  show  greater  improvement  than  those  treated  at  home.  The 
following  table  shows  the  results  with  47  cases  treated  at 
sanatoria : 

Table  IV. 

Sanatorium  Treatment  of  47  Cases. 


Results 
Obtained 

CONDITION  ON   ADMISSION 

36  Incipient 

31  Moderately  Ad- 
vanced 

Total 

Total 

Percent- 
age 

Good    Fair 

Poor 

Good 

Fair    Poor 

Good  1  Fair  , 

Poor 

Apparently  cured. 

8    f      3 

1 

' 

9,3- 

13 

25 

Arrested 

3           1 

1           2 

3           2 

2 

7 

15 

Improved 

8           2 

6           3           1 

14           5 

1 

30 

43 

Progressive 

1 

3           4 

4     j       4     1 

8 

17 

Total 

20           6 

10           8           3 

30         14 

3 

47 

100 

It  appears  from  this  table  that  out  of  47  cases  treated  at  sana- 
toria 39  cases  or  83  per  cent,  improved,  while  in  8  cases  or  17  per 
cent,  the  disease  progressed.  The  cost  to  the  Committee  in  this 
instance,  with  the  exception  of  the  amount  expended  for  10  pay 
patients  and  that  expended  for  outfits  and  transportation,  went  to 
the  families  of  the  patients  in  their  absence  at  the  sanatorium 
and  was  as  follows : 

Cost  of  Treating  47  Cases  in  Sanatoria. 

Total  number  of  weeks i,ii6 

Amount  expended $3,849.50 

Average  length  of  treatment  in  weeks  per  patient.  .  .  .  21.6 

Average  cost  per  patient $81.90 

Average  cost  per  patient  per  week $3-45 

Of  these  47  cases,  37  were  treated  in  public  sanatoria,  or  in 
free  beds  in  private  institutions;  the  other  10  were  maintained 
wholly  or  in  part  at  private  sanatoria  for  227  weeks  at  a  cost  of 
$1,451.43.  Deducting  this  from  the  above  figures,  the  amount 
actually  expended  in  the  homes  of  patients  cared  for  in  sanatoria 
is  as  follows : 


31 

Amount  of  Relief  Required  in  Homes  of  37  Patients  in  Order  that 
They  Might  Be  Treated  at  PubHc  Sanatoria. 

Total  number  of  weeks 889 

Total    cost $2,398.07 

Average  length  of  treatment  in  weeks  per  patient.  ...  24 

Average  cost  per  patient $64.81 

Average  cost  per  week  per  patient $2.69 

It  will  be  noticed  by  comparison  that  the  cost  of  home  treat- 
ment is  very  nearly  the  same  as  the  amount  of  relief  required  in 
the  homes  of  patients  in  order  that  they  may  receive  treatment  at 
free  sanatoria.  This  amount,  of  course,  represents  the  cost  to 
the  Committee  that  makes  sanatorium  treatment  possible  and  does 
not  include  the  cost  of  treating  the  patient  at  the  institution. 
Comparing  the  results  obtained  by  sanatorium  treatment  with  the 
results  obtained  through  treatment  exclusively  in  the  home,  it 
appears  that  by  the  former  method  83  per  cent,  of  the  cases 
"improved,"  while  under  home  treatment  but  51  per  cent, 
improved. 

Under  sanatorium  treatment,  in  but  17  per  cent,  of  the  cases 
the  disease  progressed,  while  under  home  treatment  the  number 
of  progressive  cases  was  49  per  cent. 

TREATMENT  IN  THE  COUNTRY. 

Many  physicians,  as  well  as  charitable  persons  and  interested 
friends,  and  nearly  always  the  sufferers  themselves,  seem  to  con- 
sider that  once  the  city  consumptive  is  taken  from  his  overcrowded 
tenement  and  placed  in  the  country  the  problem  is  solved.  Often 
it  is  thereby  merely  made  more  complicated.  On  the  other  hand, 
undoubtedly  there  are  many  consumptives  who  will  profit  greatly 
by  a' carefully  supervised  residence  in  the  country. 

In  the  year  1906  the  Committee  decided  to  send  to  the  country 
such  patients  as,  in  its  opinion,  were  suitable  for  this  kind  of 
treatment.  For  the  most  part  they  were  first-stage  cases,  with 
good  or  fair  general  condition,  well  instructed,  and  willing  and 
anxious  to  follow  advice  as  to  treatment  and  mode  of  life.  They 
were  all  patients  whose  clinic  physicians  had  recommended  the 


32 

countty  and  whose  condition  was  such  that  an  arrest  of  the  disease, 
or  at  least  a  material  prolongation  of  life,  might  reasonably  be 
looked  forward  to  if  they  could  be  taken  away  from  their  tenement 
homes  during  the  hot  summer  months,  always  a  critical  period 
for  the  consumptive. 

The  first  step  in  planning  for  this  country  care  of  consump- 
tives was  to  send  letters  to  some  600  boarding-house  keepers  and 
farmers  living  in  places  within  140  miles  radius  of  the  city,  asking 
if  they  would  furnish  separate,  well-ventilated  rooms  and  give 
good,  wholesome,  plain  food  to  a  few  consumptives  whom  the  Com- 
mittee desired  to  maintain  in  the  country  during  the  summer.  Of 
those  who  were  willing  and  seeming  able  to  offer  proper  accommo- 
dations such  were  selected  as  charged  not  more  than  $6  a  week, 
exclusive  of  laundry.  These  were  visited  by  the  Agent  of  the 
Society's  Committee  on  Employment  for  the  Handicapped,  who 
took  notes  as  to  the  situation  of  houses,  location  of  rooms,  food 
and  apparent  characteristics  of  boarding-house  keepers,  and  also 
made  observations  on  the  opportunities  for  employment.  In  this 
manner,  after  twelve  days  spent  in  driving  around  the  country 
looking  up  addresses  furnished  to  him,  reports  were  submitted  on 
28  houses,  from  w^hich  were  selected  as  suitable,  10  houses  with 
accommodations  for  about  60  patients.  The  next  thing  was  to 
secure  a  competent  physician  who  would  regularly  call  upon  the 
cases  to  make  physical  examinations,  watch  for  the  infraction 
of  rules  laid  down,  reiterate  recommendations  as  to  disposal  of 
sputum,  and  generally  give  medical  care  and  oversight  and  hear 
and  determine  complaints.  Dr.  P.  E.  Garlock,  who,  under  Dr. 
Miller,  of  the  Committee,  and  others,  had  had  previous  training 
in  the  diagnosis  and  treatment  of  tuberculosis  as  resident  physi- 
cian at  Seton  Hospital  among  the  ver}^  class  of  consumptives  with 
whom,  for  the  most  part,  the  Committee  was  dealing,  was  selected 
to  do  this  Avork,  and  it  was  due  in  no  small  degree  to  his  judgment 
and  skill  that  the  summer's  experiment  was  carried  through  with 
such  benefit  to  the  patients  and  satisfaction  to  the  Committee. 

Of  the  70  patients  sent  to  the  country,  16  were  children,  and 
were  cared  for  in  various  places  already  favorably  known  to  the 
Charity  Organization  Society,  and  were  not  visited  by  the  Com- 
mittee's physician  during  their  country  stay.     Of  the  remaining 


33 

54  adults,  50  were  under  medical  supervision  while  in  the  country. 
As  to  the  48  who  remained  in  the  country  from  one  to  five  months 
the  following  table  shows  the  results  of  this  form  of  treatment : 

Table  V. 
Country  Treatment — 48  Cases,  Treated  from  One  to  Five  Months. 


CONDITION  A^T 

BEGINNING 

Results 

10  Incipient 

38  Moderately  Ad- 
vanced 

48  Total 

Tbtal 

Percent- 
age 

Good 

Fair 

Poor 

Good 

Fair 

Poor 

Good 

Fair 

Poor 

3 

1 

1 

3 

4 

4 

8 

17 

Imjiroved 

6     I 

i;  13 

8 

1 

19 

8 

1 

38 

58 

Progressive 

ij    3 

9 

3 

9 

13 

35 

Total 

9           1 

^1     17 

30 

1 

26 

31 

1 

48 

100 

It  appears  from  this  table  that  out  of  48  cases  thus  treated  in 
the  country,  out  of  10  incipient  cases  all  improved,  and  out  of  38 
"moderately  advanced"  cases  in  but  12  or  31  per  cent,  did  the 
disease  progress — and  out  of  the  total  48  cases  in  but  12  or  25 
per  cent,  did  the  disease  progress,  while  in  36  or  75  per  cent,  the 
patients  improved. 

The  cost  of  this  treatment  and  the  detailed  facts  connected 
with  the  experiment  are  as  follows : 


Cost  of  Country  Treatment. 

Number  of  children  treated  in  country.  .  .      16 
Number  of  adults  treated  in  country 54 

Total  number  of  weeks 

Total   cost 

Average  number  of  weeks  per  patient .  .  .  . ' 

Average  cost  per  patient 

Average  cost  per  week  per  patient 


70 

821 

$5,417.61 

II-5 

77-39 

6.59 

This  total  amount  and  the  averages  include  seven  cases  in  which 


34 

a  small  amount  of  relief  ($144.38)  was  given  in  the  home  during 
the  patients'  stay  in  the  country. 


Children. 

Number  of  children 16 

Total  number  of  weeks .  . .   234 

Total   cost $793-56 

Average  number  of  weeks  per  child 14.6 

Average  cost  per  child. 49-59 

Average  cost  per  week  per  child 3.39 

Adults. 

Number  of  adults 54 

Total  number  of  weeks 587 

Total    cost $4,623.95 

Average  number  of  weeks  per  patient 10.8 

Average  cost  per  patient 85.62 

Average  cost  per  week  per  patient 7.78 

A  large  majority  of  these  patients  have  come  back  to  the  city 
improved  in  health,  hopeful  and  realizing  the  value  of  fresh  air, 
quiet,  rest  and  food,  knowing  how  to  protect  their  families  against 
infection,  and  detennined  to  do  their  part  in  the  long  struggle 
toward  health.  It  is,  however,  the  Committee's  opinion  that 
ordinarily  only  a  small  number  of  those  suffering  from  tuber- 
culosis and  seeking  charitable  assistance  are  fitted  for  residence 
in  the  country,  and  that  of  these  a  very  much  smaller  number 
may  safely  take  such  form  of  treatment  without  medical 
supervision. 

Table  VI. 
Comparative  Results  from  Various  Methods  of  Treatment. 


Results 

127  Home 

87  Day  Camp 

12  Combined 

47  Sanatorium 

48  Country 

Percentage 

Percentage 

Percentage. 

Percentage 

Percentage 

Improved 

51 

69 

75 

&3 

75 

Progressive 

49 

31 

25 

17 

25 

35 
A  SYSTEM  OF  TUBERCULOSIS  DISPENSARIES. 

One  of  the  most  important  results  that  has  grown  out  of  the 
Committee's  work  has  been  the  establishment  of  a  system  of 
tuberculosis  dispensaries  in  New  York  City.  It  has  been  the 
natural  result  of  the  coming  together  once  a  week  in  the  Confer- 
ences of  the  Committee,  of  the  physicians  representing  all  of  the 
public  tuberculosis  dispensaries  and  the  largest  private  ones  in 
the  city. 

In  this  way  there  has  been  put  into  effect  a  dispensary  district 
plan  designed  to  give  more  prolonged  and  satisfactory  observation 
and  treatment  at  each  dispensary^  to  simplify  the  work  of  visiting 
patients  in  their  homes  and  to  put  a  stop  to  the  practice,  more  or 
less  common  on  the  part  of  patients,  of  attending  for  short 
periods  one  clinic  after  another.  Having  in  mind  the  location  of 
the  dispensaries  represented  on  the  Committee,  the  density  of  the 
neighboring  population  and  the  number  of  patients  being  treated  at 
each,  the  city  was  divided  into  appropriate  districts  and  apportioned 
among  the  following  clinics :  Department  of  Health  Clinic, 
Bellevue,  Gouverneur,  Harlem  and  Presbyterian  Hospitals 
Dispensaries. 

It  was  agreed  on  behalf  of  the  above  named  dispensaries  to 
pursue  in  general  the  following  plan  for  the  treatment  of  cases 
of  tuberculosis  calling  at  these  dispensaries  for  treatment : 

(a)  In  case  of  new  applicants,  only  such  shall  be  treated  at 
the  dispensary  applied  to  as  are  living  within  the  district  assigned 
to  such  dispensary. 

(b)  In  case  of  new  applicants  living  outside  of  the  dispensary 
district  wherein  they  seek  dispensary  care,  they  shall  be  refused 
treatment  at  such  dispensary  of  original  application,  and  shall  be 
referred  by  card  to  the  dispensary  assigned  to  the  district  of  their 
residence. 

(c)  Old  cases  already  in  attendance  at  these  dispensaries  shall 
be  continued  under  such  treatment  without  reference  to  their 
place  of  residence. 


36 


W5Q&I 

HEALTH  DEFT 

.,  E.545t 


MANHATTAN. 

Note. — Manhattan  applicants  for  examina- 
tion or  treatment  should  apply  at  the  dis- 
pensary in  the  district  in  which  they  live. 
The  dispensary  districts  are  shown  on  the 
map. 

Dispensaries. 

Department  of  Heaeth, 
55th    St.    and    6th    Ave., 

Week  days   10  A.  M.  to  4  P.  M. 
Mon.,   Wed.,   Fri.,  8  to  9   P.    M. 

Bellevue   Hospitae   Dispensary, 
Foot  of  East  26th   St., 

Week    days    i    to    3    P.    M. 

GouvERNEUR  Hospitae  Dispensary, 
Gouverneur    Slip, 

Mon.,  Wed.,  Fri.,  2  to  4  P.  M. 

Presbyterian    Hospital   Dispensary, 
70th    St.    and    Madison   Ave., 

Mon.,  Wed.,  Fri.,  1.30  to  3    P.  M. 

Hareem  Hospital  Dispensary, 
I36tli    St.    and   Lenox    Ave., 
Week    days    3   to   4   P.    M. 

Vanderbiet   Ceinic, 

60th    St.    and    Amsterdam    Ave., 
Week  days  2  to  3  P.  M. 
Mon.,  Wed.,  Fri.,  9  to  10.30  A.  M. 

New   York   Dispensary, 
137   Center    St., 

Week  days   11  A.   M.  to   12.30  P.  M. 

New   York   Hospital  Dispensary, 
8   West    i6th   St., 

Week   days  2   to  4  P.    M. 

Mt.    Sinai   Hospital   Dispensary, 
Madison  Ave.  and  looth  St., 
Week  days    10  to    11    A.    M. 

German    Hospital    Dispensary, 
76th    St.    and    Park    Ave., 

Week  days  2  to  4  P.   M. 

Health    Department,    Bronx, 

3d   Avenue    and    St.    Paul's    Place, 
Week  days  2  to  4  P.  M. 


The  Clinics  and  Districts  of  the  Association  of  Tuberculosis 
Clinics — An  Outgrowth  of  the  Committee's  Work. 


37 

Since  the  beginning  of  this  plan  it  has  been  further  extended 
to  take  in  Vanderbilt  CHnic,  New  York  Dispensary  and  New  York 
Hospital  Dispensary,  and  at  present  a  number  of  other  dispen- 
saries have  under  consideration  the  Committee's  invitation  to  join 
the  group  of  "The  Association  of  Tuberculosis  Clinics,"  as  these 
dispensaries  are  now  called.  The  requirements  for  admis- 
sion are  that  the  dispensary  shall  agree  to  treat  only  appli- 
cants living  within  the  district  which  by  mutual  consent 
may  be  apportioned  to  it,  that  patients  shall  be  regularly 
visited  in  their  homes,  and  that  a  representative  of  the 
dispensary  shall  be  appointed  as  a  delegate  to  attend  the 
meetings  of  the  Association.  The  experience  of  those  who 
have  already  been  members  of  this  group  for  twelve  months 
proves  that  the  system  is  simple  and  effective,  that  it  gives  the 
physician  a  better  knowledge  of  his  patient  than  he  had  before,  that 
it  makes  attendance  of  patients  more  regular  and  is  a  great  time 
saver  to  the  nurse,  that  it  is  easier  and  more  satisfactory  to  the 
patient  and  that  far  from  reducing  the  number  of  cases  which 
will  be  available  for  teaching  purposes,  it  increases  this  number. 
As  a  matter  of  fact,  the  attendance  at  the  clinics  as  a  whole  has 
been  considerably  increased  since  the  district  system  was  put  into 
operation.  Many  of  the  clinics  are  overcrowded,  and,  while  the 
work  of  the  nurses  has  been  greatly  facilitated  by  the  district  plan, 
the  work  of  the  doctors  at  the  clinics  has  been  somewhat 
increased.  This  calls  for  an  increase  in  the  number  of  dispen- 
saries having  special  classes   for  the  treatment  of  tuberculosis. 

During  the  past  year  1,163  patients  have  been  referred  to 
their  proper  districts  among  the  eight  dispensaries  now  forming 
the  Association,  in  accordance  with  this  district  plan. 

At  a  recent  meeting  "The  Association  of  Tuberculosis  Clinics" 
was  formally  organized,  for  the  purpose  of  promoting  co-opera- 
tion between  the  tuberculosis  dispensaries  and  to  further  the  devel- 
opment of  tuberculosis  dispensary  work.  It  is  hoped  through 
this  association  to  largely  increase  the  number  of  special  clinics 
treating  tuberculosis  and  so  to  reduce  the  present  congested 
situation  in  the  tuberculosis  clinics. 


38 

EXTRA-DISPENSARY  TREATMENT. 

The  work  that  the  members  of  the  Committee  have  performed 
together  has  strengthened  their  behef  that  for  the  satisfactory 
hospital  and  dispensary  treatment  of  tuberculosis  in  New  York 
City,  there  must  be  brought  about  a  closer  co-ordination  than 
now  exists  between  the  dispensaries  and  hospitals  and  that  certain 
changes  in  hospital  and  dispensary  methods  are  essential. 

In  the  segregation  of  advanced  cases  and  the  care  of  the  desti- 
tute and  needy,  in  the  physical  improvement  of  some  patients  and 
in  lessons  in  prevention  and  cure  offered  in  the  daily  experience 
of  institutional  life,  hospitals  play  an  important  and  necessary 
part  in  au}^  scheme  for  the  municipal  control  of  tuberculosis.  But 
there  are  certain  patent  defects  that  must  be  remedied  before 
these  hospitals  will  do  that  which  it  is  not  unreasonable  to  expect 
of  them.  Over- feeding  and  fresh  air  methods  are  not  sufficiently 
carried  out  in  hospitals,  instruction  to  patients  and  their  visiting 
friends  is  many  times  not  thoroughly  given,  under  one  roof  are 
often  cared  for  vagrants,  vicious,  alcoholic  and  respectable  work- 
ing people,  chronic,  advanced  and  early  cases.  At  present  we 
build  expensive  institutions,  we  elaborate  a  costly  method  for 
detecting  cases  that  need  hospital  treatment,  public  and  private 
energy  is  expended  to  induce  the  consumptive  poor  to  enter 
hospitals.  Too  often  finding,  however,  that  the  hospital  is  not 
what  he  had  expected,  the  patient's  one  desire  is  to  get  away,  and 
this,  even  though  destitute  and  homeless,  he  does  as  soon  as  possi- 
ble, taking  with  him  a  story  of  dissatisfaction  which  spreads 
among  his  neighbors.  And  thus  are  kept  from  the  hospitals  others 
whom  physicians,  nurses,  inspectors  and  charity  visitors  have  been 
urging  to  leave  their  homes  for  the  fresh  air,  the  good  and 
abundant  food  and  the  rest  and  quiet  of  the  hospital. 

With  the  dispensaries  the  case  is  somewhat  analogous — 
patients  are  treated,  but  not  as  experience  and  observation  show 
is  necessary  if  results  are  to  be  obtained  most  helpful  to  patients 
and  satisfactory  to  clinic  physicians.  To  secure  this  there  are 
needed,  in  the  first  place,  salaried  dispensary  physicians,  clerical 
help  and  more  nurses.  The  salaries  required  to  attract  to  this 
service  competent  young  physicians  need  not  be  large.     But  for 


39 

the  lack  of  a  medical  service  that  might  be  obtained  at  a  modest 
price  several  dispensaries  are  now^  badly  crippled  and  dependent 
upon  the  entirely  fortuitous  circumstance,  that  they  are  being- 
served  by  enthusiasts  who  are  now  much  overworked  and  quite 
unable  to  give  that  detailed  attention  to  their  patients  which  in 
tuberculosis  is  particularly  essential  to  adequate  treatment.  To 
the  young  practitioner  in  search  of  a  livelihood  the  examination 
and  diagnosis  of  tuberculosis  after  a  very  few  months  seems  of 
comparatively  little  practical  value  and  he  abandons  it  for  the 
study  of  more  widely  varied  types  and  for  a  service  that  does  not 
carry  with  it  such  feared  possibility  of  infection. 

And  further,  between  hospitals  and  dispensaries  there  is  not 
now  that  amount  of  co-operation  that  is  desirable  and  might  be 
had  without  much  added  effort  or  expense.  Dispensary  cases  do 
not  enter  hospitals  with  any  dispensary  report,  and  each  case 
must,  therefore,  be  taken  up  by  the  hospital  physicians  without 
the  help  that  such  reports  might  furnish.  On  the  other  hand, 
cases  are  discharged  from  hospitals  and  left  to  report  to  dispen- 
saries, or  not,  as  they  may  choose,  no  especial  effort  being  made 
to  secure  the  continuance  at  dispensaries  of  medical  supervision 
carried  out  at  hospitals,  and  no  report  of  observations  made  at 
hospitals  is  given  to  patients  to  aid  the  clinic  physician  in  diagnosis 
and  recommendation  as  to  treatment. 

CONCLUSIONS. 

I.  Home  Relief  in  Advanced  Cases  Dangerous  Substi- 
tute FOR  Isolation  in  Hospital. — As  a  general  rule,  subject 
to  but  few  exceptions,  so  far  as  the  Committee's  experience  is 
concerned,  applicants  for  charitable  aid  because  of  tuberculosis 
have  the  disease  in  such  marked  form,  that  the  main  considera- 
tion, from  a  medical  point  of  view,  is  one  of  preventing  them 
from  infecting  the  other  members  of  their  households.  The 
attempt  at  cure  or  arrest  of  the  disease  is  not  infrequently  fur- 
ther greatly  complicated  by  the  ignorance,  bad  habits  and  the 
poverty  of  the  applicants.  The  Committee  is  therefore  strongly 
of  the  opinion  that  in  New  York  City  relief  in  the  homes  of  con- 
sumptives in  a  far  advanced  stage,  is  from  the  medical  point  of 
view  for  the  most  part  an  unsatisfactory  and  dangerous  substi- 


40 

tiite  for  the  isolation  provided  by  the  hospitals.  But  it  is  one  thing 
to  advise  a  patient  to  go  to  a  hospital,  it  is  quite  another  to  get 
him  there.  Often  he  will  not  believe  he  is  sick  enough  for  a 
hospital,  or  if  he  has  not  been  able  to  live  comfortably  he  wants 
at  least  to  die  in  peace  with  his  family  around  him.  Often  the 
going  means  that  none  are  left  at  home  to  "mind  the  children" 
or  that  the  home  will  be  broken  up. 

We  strongly  urge  the  importance  of  gradually  overcoming 
those  natural  objections  by  persistent  effort.  Of  foremost  nec- 
essity is  the  improvement  in  the  care  and  comfort  aflorded  such 
patients  in  the  various  hospitals  devoted  to  their  use,  and  the 
erection  of  an  additional  number  of  such  hospitals. 

II.  Home  Relief  Inevitable. — Home  relief  and  home 
treatment  are  inevitable  in  the  solution  of  New  York  City's  tuber- 
culosis problem.  Avoid  it  by  better  things  as  often  as  we  can, 
we  must  at  last  face  the  constantly  recurring  problem  of  "home 
relief  of  consumptives."  Is  it  a  problem  impossible  of  solution? 
Yes,  in  an  overwhelming  and  appalling  majority  of  cases,  if 
by  relief  is  meant  cure  and  given  only  the  means  and  methods 
now  available.  It  is  time  that  this  be  realized  and  ackno^vl- 
edged,  that  there  are  over  30,000  tuberculous  persons  in  the  New 
York  Citv  tenements,  the  most  of  whom  will  never  see  the  m- 
side  of  a  hospital,  though  a  smaller,  yet  still  large  number,  will 
enter  the  hospitals  only  to  die  there,  and  that  such  treatment  as 
the  great  army  of  sufferers  is  to  receive  is  to  be  given  in  the 
New  York  City  tenements. 

The  selection  of  cases  suitable  for  home  relief  should  be  made 
very  carefully  after  combined  medical  and  social  investigation. 
AA'^hen  once  such  relief  is  determined  upon  it  is  necessary  for 
anv  permanent  effect  in  these  cases  that  it  should  not  merely  be 
adequate  to  relieve  want,  but  that  it  should  be  abundant  enough 
to  make  the  patient  gradually  recover  his  lost  strength  and  thus 
overcome  his  disease.  And  furthermore,  such  relief  must  be 
continued  over  a  long  period  of  time.  It  is  especially  important 
that  patients  returning  home  from  sanatoria  with  their  disease 
apparently  cured  or  arrested,  should  be  given  every  necessary 
aid  to  secure  favorable  environment  or  employment  in  order  to 
guard  against  relapse. 


41 

III.  Cure  in  the  Tenement  Most  Difficult. — The  cure 
of  tuberculosis  in  a  New  York  City  tenement  is  far  more  difficult 
to  accomplish  than  it  is  under  any  other  conditions.  We  have 
only  to  compare  the  treatment  given  in  the  best  sanatoria  with 
the  best  treatment  that  is  possible  in  the  tenements  to  demonstrate 
the  fact.  The  sanatorium  provides  for  its  patients,  day  and 
night,  an  abundance  of  air — good,  fresh,  bracing  air;  food  is 
given  of  the  best  quality  and  in  large  quantities,  and  milk  and 
eggs  between  meals  is  usually  added.  Freedom  from  work  is 
an  essential  part  of  the  treatment,  even  many  times  to  the  ex- 
tent of  complete  rest  and  the  avoidance  of  the  slightest  exercise ; 
the  patient  is  carefully  watched  from  day  to  day  by  a  physician 
and  every  little  idiosyncrasy  of  the  patient,  mental  as  well  as 
physical,  is  observed  in  suiting  the  treatment  to  his  various  and 
changing  needs.  Life  is  made  easy  and  comfortable  for  him, 
and  every  attempt  is  made  to  banish  worry  from  his  mind.  Even 
with  such  treatment  success  can  be  the  outcome  only  if  the  sick 
man  was  not  too  sick  when  he  entered  the  sanatorium  and  even 
then  only  if  he  has  the  will  to  get  well  and  the  intelligence  to  do 
his  part  during  the  institutional  training.  And  if  worries  are 
present  while  he  is  "taking  the  cure,"  and  if  he  must  go  back 
into  his  old  manner  of  life,  even  of  this  carefully  selected  and 
carefully  treated  group,  the  number  is  few  of  those  who  will  even- 
tually retain  the  modicum  of  health  they  have  fought  hard  and 
bitterly  to  regain. 

The  mere  statement  of  what  are  regarded  as  essentials  ior 
such  success  as  the  sanatoria  can  show  is  sufficiently  con- 
vincing for  those  who  know  the  New  York  City  tenement  and  its 
life.  Air  really  fresh ;  food,  good  and  abundant ;  freedom  from 
work  and  worry ;  constant  medical  oversight ;  intelligence  and 
ability  to  co-operate  with  the  physician ;  and  then  suitable  em- 
ployment when  the  cure  shall  have  been  effected  and  an  income 
therefrom  sufficient  to  provide  the  air  and  food  necessary  if  a 
relapse  is  not  to  be  after  all  the  final  outcome  of  the  long,  hard 
struggle,  where  are  these  to  be  found  by  the  crowded  and  con- 
stantly more  crowded  New  York  City  tenement  dweller  ?  The 
problem,  though  difficult,  is  not  altogether  impossible,  and  already 
we  may  see  glimpses  of  hope  for  the  future.  It  is  very  gratify- 
ing to  note  that  despite  the  unfavorable  conditions  under  which 


42 

we  labor  in  New  York  City  more  than  50  per  cent,  of  the  cases 
which  the  Committee  treated  in  their  homes  during  the  past  year 
improved.  Three  were  apparently  cured,  and  in  seventeen  cases 
the  disease  was  arrested.  This  is  at  least  an  earnest  of  what  might 
be  accomplished  if  the  treatment  might  be  continued  over  a  longer 
period  of  time.  Undoubtedly  patients  can  be  cured  in  the  City 
of  New  York,  by  patient  and  persistent  care  under  prope** 
medical  supervision. 

I\^.  Day  Camp  A'aluable  in  Solutiox  of  Tuberculosis 
Problem.- — If  our  short  experience  this  summer  in  connection 
with  our  day  camp  is  of  value  and  if  the  results  as  presented 
bear  any  significance,  and  if,  as  we  believe,  the  home  treat- 
ment of  great  numbers  is  necessar}-,  then  we  are  forced  to  admit 
that  the  day  camp  or  day  sanatorium  must  in  the  future  play 
an  important  part  in  treating  the  tuberculous  thousands  of  New 
York,  who  must  or  will  remain  at  home.  It  is  evident  from 
our  experience  of  last  summer  that  many  patients  would  attend 
day  camps  if  they  were  located  in  positions  which  could  be 
easily  reached. 

AVe  would  recommend,  therefore,  the  establishment  of  a  num- 
ber of  day  camps,  accessible  to  the  various  tenement  sections  of 
the  city  with  provision  in  connection  therewith  for  careful  home 
treatment  and  adequate  relief  for  needy  cases,  under  care  of  one 
or  more  of  the  special  tuberculosis  clinics. 

V.  CouxTRY  Care  of  Consumptives. — Our  experience  with 
the  care  of  70  patients  in  the  country  confirms  more  strongly  the 
opinion  that  this  method  of  treatment  is  neither  safe  nor  satis- 
factory as  a  general  practice.  It  is  very  difficult  to  keep  any  care- 
ful and  adequate  supervision  of  persons  thus  sent  out  and  as  a  rule 
those  who  are  dependent  upon  charitable  organizations  cannot 
be  relied  upon  to  observe  the  proper  and  necessar\-  precautions 
when  once  they  have  tasted  the  freedom  of  countri-  life.  Liberty 
with  these  persons  too  frequently  leads  to  indulgence  and  has  a 
bad  result.  Although  every  possible  precaution  was  taken  in 
instructing  the  patients  and  supplying  them  with  the  proper  means 
of  disposing  of  their  sputum,  numbers  of  complaints  were  re- 
ceived from  the  boarding-houses  where  the  patients  were  sent. 


43 

We,  therefore,  urge  that  the  greatest  precautions  be  observed  in 
recommending  or  advising  the  use  of  this  popular  method  of 
treating  tuberculous  patients.  While  the  fresh  air  of  the  country 
is  splendid  for  any  sufferer  from  lung  diseases,  it  is  not  the  best 
course  of  treatment  when  medical  and  other  supervision  is  want- 
ing or  inadequate.  It  seems  to  us  that  the  only  instances  in  which 
it  is  safe  or  desirable  to  pursue  this  method  of  treatment  are 
arrested  or  early  stage  cases  who  have  been  thoroughly  trained 
through  a  long  period  of  time  and  who  can  be  relied  upon  to 
observe  the  precautions  necessary  to  prevent  the  infection  of 
those  with  whom  they  live,  and  in  whom  proper  care  of  their 
own  health  has  become  a  fixed  habit. 

VI.  Church  Classes. — The  principle  of  "giving  a  large 
amount  of  attention  to  a  small  number  of  patients"  has  been  best 
exemplified  in  the  church  tuberculosis  classes.  The  results  ob- 
tained by  this  method  have  been  excellent  and  undoubtedly  excel 
those  obtained  by  the  larger  dispensaries  even  with  the  present 
district  plan.  This  Committee  wishes,  however,  to  emphasize 
its  belief  that  such  classes  are  necessarily  very  limited  in  their 
sphere  of  usefulness  and  offer  no  solution  of  the  great  problem 
of  the  home  care  of  the  whole  mass  of  tuberculous  poor,  unless 
they  should  be  willing  to  take  charge  of  a  definitely  defined  dis- 
trict or  unless  they  should  be  run  in  connection  with  one  of  the 
tuberculosis  dispensaries.  We  believe  by  the  establishment  of 
more  and  more  special  dispensaries  and  the  subsequent  division 
of  the  city  into  small  districts,  that  eventually  quite  as  good 
results  can  be  obtained  by  the  dispensary  as  by  the  church  class. 
The  underlying  principle  of  class  work  could  even  now  be  very 
easily  carried  out  by  special  workers,  voluntary  or  otherwise, 
devoting  their  time  to  a  special  group  of  patients  in  any  dispensary. 

VII.  The  Evolution  of  the  Dispensary  District  Plan. — 
Bearing  in  mind  as  we  do  the  infectious  nature  of  tuberculosis 
and  what  few  resources  the  tenement  house  dweller  has  for  suc- 
cessfully overcoming  all  the  many  disadvantages  under  which 
he  labors  in  fighting  this  ''disease  of  the  tenements,"  we  lay 
especial  stress  upon  the  extension  and  perfection  of  the  dispensary 
system   of  which  the   foundations  have  already  been   laid ;   and 


44 

this  despite  the  fact  that  the  members  of  this  Committee  as  chiefs 
of  the  associated  tuberculosis  chnics  are  only  too  conscious  of 
the  meagre  results  obtained  and  obtainable  in  endeavoring  to 
effect  permanent  cures  at  dispensaries.  It  is  believed,  however, 
that  the  dispensary  in  charge  of  a  district  ever  growing  smaller 
as  new  dispensaries  undertake  this  work,  with  its  visiting  nurse 
making  more  and  more  frequent  inspections  of  the  home  condi- 
tions of  the  patients,  with  examinations  made  compulsory  of  all 
members  of  a  household  in  which  a  case  of  tuberculosis  shall  be 
registered,  with  emplo3'ers  and  employees  co-operating  with  the 
dispensaries  to  secure  competent  and  early  examinations  of  the 
greatest  possible  number  of  employees,  with  school  and  health 
authorities  working  for  the  thorough  examination  of  school  chil- 
dren, it  is  believed  that  along  these  lines  will  be  found  the  greatest 
promise  of  satisfactory-  results  in  the  treatment  of  tuberculosis 
in  the  New  York  City  tenement.  Thus  will  be  detected  early 
cases  among  those  whose  labor  is  of  a  character  favorable  to 
the  contracting  of  tuberculosis,  whose  homes  are  unsanitary  and 
further  endangered  by  the  presence  of  tuberculosis,  and  who  badly 
nourished  and  badly  housed  now  too  often  work  too  long  in  badly 
ventilated  shops  until  tuberculosis  claims  them  as  its  victims. 
A  dispensar}-  system  thus  examining  and  advising  where 
experience  tells  tuberculosis  will  be  found,  will  cure  because 
it  will  detect  cases  in  time  to  send  them  away  to  city  hos- 
pitals and  countrv  sanatoria,  and  it  will  prevent  because  it  will 
so  carefully  instruct  its  patients  and  so  diligently  keep  watch  and 
ward  over  its  neighborhood  that  infection  will  not  be  spread 
broadcast  as  now  it  is  by  careless  consumptives  and  those  ignor- 
ant that  they  have  consumption.  That  this  is  not  to  be  accom- 
plished at  once  is  recognized,  that  it  will  cost  is  admitted,  but 
that  it  is  to  the  dispensary  that  appeal  must  be  made  to  find 
the  curable  and  guide  the  incurable,  we  insist.  Thus  will  the 
30.000  sources  of  infection  in  this  city  be  brought  under  con- 
trol and  prevented  from  carelessly  spreading  their  disease.  While 
the  diverse  forces  that  are  working  for  prevention  are  slowly 
accomplishing  their  results  the  dispensary  system  will  be  holding 
out  a  promise  of  cure  to  the  sick  and  a  hope  of  safety  to  the 
healthv. 


45 

VIII.  Educational  and  Preventive  Measures. — We  be- 
lieve that  every  energy  and  much  more  than  is  now  used  must  be 
bent  toward  the  prevention  of  this  preventable  disease.  The  solu- 
tion of  the  tuberculosis  problem  lies  here,  rather  than  in  the  cure  of 
those  who  are  now  suffering  with  the  disease.  We  recommend, 
therefore,  the  continuance  and  development  of  the  educational 
agencies  already  at  work,  together  with  such  new  methods  as 
may  from  time  to  time  become  expedient ;  and  the  legislative 
control  of  such  recognized  causes  of  contagion  as  spitting  in 
public  places,  dry  sweeping  of  streets,  use  of  dark  rooms  in 
tenements  for  sleeping  purposes. 

IX.  Examination  of  Families. — Of  first  importance  in 
preventing  the  spread  of  contagion  is  the  careful  supervision  of 
the  homes  of  consumptives.  Probably  the  persons  most  exposed 
to  contagion  from  tuberculosis  are  those  who  are  constantly 
associated  with  persons  suffering  from  the  disease  and  under 
conditions  which  for  persons  with  strong  constitutions  are  not 
propitious.  These  conditions  undoubtedly  prevail  to  a  very  con- 
siderable extent  in  thousands  of  tenement  homes  in  New  York 
City.  Something  should  be  done  not  alone  to  educate  the  con- 
sumptive and  those  associated  with  him,  but  to  discover  in  the 
early  stage  those  who  are  infected  with  the  disease  and  then  by 
careful  instruction  and  persistent  watching  either  effect  a  cure, 
or  at  least  prevent  the  persons  from  becoming  careless  sources 
of  infection.  No  preventive  measure  is  sO  valuable  as  the  proper 
protection  against  the  source  of  infection.  We  recommend, 
therefore,  that  upon  the  first  discovery  of  tuberculosis  in  the 
home,-  whether  by  private  physician  or  public  dispensary,  every 
member  of  the  household  should  be  immediately  examined  and 
carefully  instructed  as  to  precautions  necessary  to  prevent  or 
cure  the 'disease.  A  beginning  along  these  lines  has  been  made 
by  the  establishment  of  the  children's  clinics. 

X.  Co-Operation. — Too  much  cannot  be  said  of  the  results 
accomplished  during  our  past  two  years'  work  in  the  establish- 
ment of  co-operative  relationship  between  the  several  tuberculo- 
sis clinics  and  between  these  clinics  and  the  social  workers.  The 
mutual  education  has  been  exceedinglv  valuable.     The  difficul- 


46 

ties  confronting  social  workers  have  been  brought  very  clearly 
and  forcibly  to  the  attention  of  the  clinic  physicians  and  on  the 
other  hand  the  problem  of  medical  treatment  at  public  dispen- 
saries has  been  newly  impressed  upon  those  engaged  in  the  solu- 
tion of  the  social  problem.  This  more  accurate  understanding 
of  their  respective  problems  has  brought  these  two  essential 
forces  into  very  sympathetic  relationship  and  has  established  the 
basis  for  a  common  standard  in  the  management  of  dependent 
families,   whose  main   cause  of  dependence  is  tuberculosis. 

Reviewing  the  work  of  the  Committee,  which  has  extended 
over  a  period  of  20  months,  and  summing  up  the  results  of  its 
efforts,  we  believe  that  we  have  made  the  following  contributions 
to  the  solution  of  the  tuberculosis  problem  : 

1.  A  demonstration  of  the  methods  of  relief  necessary  for 
proper  Home  Treatment^  together  with  a  comparative  study  of 
the  results  obtained  and  expenses  entailed  by  this  and  other 
methods  of  treatment. 

2.  The  establishment  of  a  Dispensary  District  system 
looking  forward  to  the  ultimate  dispensary  control  of  tubercu- 
losis. 

3.  The  demonstration  of  the  feasibility  of  the  use  of  the  Day 
Camp  in  connection  with  home  treatment  of  tuberculosis  in  New 
York  City. 

4.  A  careful  study  of  the  actual  value  that  can  be  attached 
to  the  ordinary  country  care  of  consumptives. 

5.  The  establishment  of  Co-Operative  Relationship  be- 
tween the  tuberculosis  clinics  and  social  workers. 

James  Alex.  Miller,  M.  D.,  Chairman. 
R.  A.  Fraser,  M.  D.  W.  F.  Persons, 

James  C.  Greenway,  M.  D.         Henry  L.  Shively,  M.  D. 
S.   F.   Hallock,   M.   D.  A.  M.  Shrady,  M.  D. 

J.  H.  Huddleston,  M.  D.  B.  H.  Waters,  M.  D. 

Walter  L.  Niles,  M.  D.  Gaylord   S.   White, 

Henry  S.  Patterson,  M.  D.  -      Paul   Kennaday,   Secretary. 
Frank  H.Mann,    Asst.  Secretary. 


47 

TUBERCULOSIS  RELIEF  FUND. 

Receipts  and  Disbursements. 
February   28   to    September   30,    igo6. 

■  Receipts. 
Contributions  : 

Robt.   S.   Brewster $2,500.00 

Andrew    Carnegie 1,000.00 

Harvey  E.    Fisk 500.00 

Edward   S.   Harkness 5,000.00 

John   S.    Huyler 500.00 

V.   Everit   Macy 1,000.00 

John   D.    Rockefeller 7.500.00 

Grant  B.  Schley 2.500.00 


20,500.00 

William  R.   Woods 10.00 

St.  George's  Society 8.00 

Refunds 70.80 

Unexpended  balances    162.08 

Interest 423.57 


$21,174.45 


Disbursements. 

Administration  Expenses  : 

Salaries    $705.40 

Printing  and  stationery 47.60 

Petty   expenses    156.37 

Relief : 

Transportation     404.35 

Food  1,967.04 

Clothing    426.49 

Furniture,  etc 193-45 

Medical  supervision  and  supplies 522.72 

Nurse's  salary  and  expenses 187.81 

Care   in    sanatoria 657.91 

Country  board  3.909.58 

House   cleaning    206.13 

Wage   loss    750.98 

Miscellaneous    88.24 


$909-37 


510,996.6 1 
$11,905.98 

Loan    for    expenses    of    Committee    on     the     Prevention     of 

Tuberculosis 1,000.00 

Balance  on  hand  September  30,  1906 8,268.47 


$21,174.45 

I  have  examined  this  account  with  vouchers  and  find  same  correct. 
(Signed)         Frederick  C.  Manvee,  Auditor. 
Certified  Public  Accountant  of  the  State  of  New  York. 


48 

TUBERCULOSIS   RELIEF  FUND. 

Receipts  and  Disbursements. 

October   i,    1906  to  November  30,   1907. 

Receipts. 

Balance  on  hand  October  i,  1906 $8,268.47 

Contributions  : 

Brewster,  Robert  S $2,542.22 

Harkness,  Edward    S 1,000.00 

Macy,   V.    Everit 1,000.00 

-. 4,542.22 

Special  contributions   to   Day   Camp 1,210.15 

Interest   on   bank  balances 136.20 

Return  of  Loan  from  C.   P.  T.,  General.  1,000.00 

Refunds     168.23 

Transfers : 

From   Provident  Relief   Fund 3,844.00 

From  C.    P.   T.,  General 2,421.15       6,265.15     13,321-95 

$21,590.42 
Disbursements. 
Administration: 

Salaries  and  wages 2.840.76 

Furniture  and  fittings 90.00 

Sundry     263.85 

3,19461 

Relief : 

Rent    4,382.55 

Furniture     334-84 

Medicine    89.22 

Clothing     984.61 

Food     4,210.95 

Board     1,630.64 

Transportation    410.28 

Sanatorium  278.04 

Wage   loss    1,487-78 

Miscellaneous     190.91 

Washing    52-44 

Pensions  and  grants 1,553-34 

15,605-60     - 

Day  Camp. 

Equipment : 

Supplies    $515-82 

Wages  - 51-56 

567.38 

Maintenance : 

Supplies    474-50 

Medical  supplies    32-51 

Wages     806.13 

Contingent   25. co 

Milk  and  eggs 686.19 

Washing     16.75 

Carfares    181.75     2,222.83      2.790.21 

$21,590.42 

We  have  audited  the  receipts  and  disbursements  of  the  Tuberculosis 
Relief  Fund  of  the  Charity  Organization  Society  of  the  City  of  New  York 
for  the  period  ended  November  30,  1907,  and 

We  Hereby  Certify  that  the  foregoing  statement  is  correct. 

(Signed)         Haskins  &  Seles, 
New  York,  February  21,  1908.  Certified  Public  Accountants. 


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